Dupilumab
A very effective biologic for AE treatment seems to be dupilumab [75], a human monoclonal antibody that binds IL-4Rα thereby blocking type 2 inflammation and restoring epidermal barrier [129, 130]. It has been shown that dupilumab improves symptoms and severity of disease, as well as AE-related serum biomarkers even in a subset of very difficult-to-treat AE patients [131]. Dupilumab has been recently approved as the first biologic treatment for children with moderate and severe AE. Albeit current data suggest no harmful effects of dupilumab on animal fetus, possible risks associated with exposure of the biologic during pregnancy in women have to be still further investigated [132]. Overall, the acceptance of the biologic agent seems high as reflected in the very long drug survival or compliance time of the patients [133]. This is strongly connected with the benefit of improving symptoms and disease severity, reducing the use of rescue medications and improving the quality of life and in parallel with a low risk for adverse events [134, 135]. Ocular (conjunctivitis) and local reactions have been reported as the major adverse effects in dupilumab-treated patients [127]. Dupilumab has also proved efficacy in a study with another systemic Th2 disease, chronic rhinosinusitis with nasal polyposis: Treatment with the antibody resulted in reduction of multiple biomarkers of type 2 inflammation in nasal secretions and polyp tissues [136], but also perennial allergic rhinoconjunctivitis and perennial allergic asthma symptoms [137].